Sudden Visual Loss Flashcards
list some conditions that cause sudden visual loss
central retinal artery occlusion central retinal vein occlusion retinal detachment vitreous haemorrhage optic neuritis wet ARMD
list some risk factors for developing CRAO
diabetes atherosclerosis hyperlipidaemia giant cell arteritis emboli from carotid artery disease
are CRAO and CRVO painful or painless losses of vision
painless
what are the examination findings (fundoscopy) of CRAO
RAPD
cherry red spot on macula
pale oedematous retina with thread like vessels
how is CRAO treated
if present within 24 hours try to convert to branch occlusion by giving IV acetazolamide and ocular massage
how does branch occlusion differ from central occlusion
branch is a less severe form, visual loss is less profound
which is more common, CRAO or CRVO
CRVO
list some risk factors for developing CRVO
age hyperviscosity raised IOP diabetes/sarcoidosis hypertension
what are the examination findings of CRVO
swollen optic disc
dilated tortuous vessels
retinal flame haemorrhages
cotton wool spots +/- neovascularisation
what is amaurosis fugax
transient blockage of central retinal artery
think of as TIA is the eye
what is the clinical presentation of amaurosis fugax (buzzword)
sudden painless vision loss
curtain coming down over the eye lasting less than 5 mins
how is CRVO treated
allow time to heal
intravitreal anti VEGF injection
optic neuropathy is sub-divided into which 2 types
arteritic and non-arteritic
what causes arteritic optic neuropathy
giant cell arteritis - presents with sudden vision loss with headache, jaw claudication and scalp tenderness
how is arteritis optic neuropathy managed
high dose prednisolone, vision loss is permanent but prevention is key
what is the typical patient presenting with non-arteritis optic neuropathy
a hypermetrope aged 45-60 who smokes, presentation same as arteritic
what is a vitreous haemorrhage
bleed that arises from retinal neovascularisation
list the causes of vitreous haemorrhage
diabetes
CRVO/BRVO
retinal tears
retinal detachment
what are the examination findings of vitreous haemorrhage
loss of red reflex
no RAPD
sudden vision loss
how is vitreous haemorrhage treated
usually spontaneously resolves
what are the risk factors for retinal detachment
myopia (short sightedness) as eyes are bigger
retinal tar
trauma
secondary to diabetes
what is the presentation of retinal detachment
curtain coming down over eyes lasting >5 minutes
flashes and floaters
RAPD
detached wrinkly retina
how is retinal detachment managed
surgery
laser
prognosis usually good
what conditions cause optic neuritis
multiple sclerosis
ethanbutol use and syphilis less common
optic neuritis is painless/painful and unilateral/bilateral visual loss
painful
unilateral
outline the features of optic neuritis
central scotoma
reduces colour vision
on examination RAPD, enlarged blind spot
what is a central scotoma
loss of central field of vision
how is optic neuritis managed
investigate for MS
IV prednisolone to speed up recovery but acuity is not improved
what causes aged related macular degeneration to arise
pigment and drusen are produced at the macula leading to retinal atrophy and central retinal detachment
list the risk factors for developing ARMD
increasing age
smoking
cardiovascular risk factors
cataract surgery
what are the 2 types of ARMD
wet and dry
how to wet and dry ARMD differ
wet - sudden visual loss, arises when choroidal neovascular membranes develop under the retina which leak fluid
dry - general wear and tear of the macula, gradual vision loss
describe the presentation of wet ARMD
on examination fluid exudation and detachment of pigment
metamorphopsia - distorsion of central vision
how is wet ARMD managed
stop smoking
anti VEGF intravitral injection
